Levofloxacin Versus Ciprofloxacin-Based Prophylaxis during the Pre-Engraftment Phase in Allogeneic Hematopoietic Stem Cell Transplant Pediatric Recipients: A Single-Center Retrospective Matched Analysis

Infectious complications are the most common and significant cause of mortality and morbidity after allogeneic hematopoietic stem cell transplantation (HSCT). Antibacterial prophylaxis in pediatric cancer patients is a controversial issue. Our study compared the outcomes of levofloxacin versus ciprofloxacin prophylaxis in allogeneic HSCT pediatric recipients treated for hematological malignancies. A total of 120 patients received levofloxacin prophylaxis, and 60 patients received ciprofloxacin prophylaxis. Baseline characteristics such as age, gender, primary diagnosis, type of conditioning, donor type, stem cell source, and supportive care of the patients were similar, and duration of antibiotics prophylaxis was similar. Both prophylaxis regimens demonstrated the same efficacy on the risk of febrile neutropenia and severe complications such as sepsis, the same rate of overall mortality, hospital readmission, and length of hospital stay. Levofloxacin prophylaxis was associated with significantly lower cumulative antibiotic exposure. The median of Gram-positive infection-related antibiotic days was 10 days in the levofloxacin group versus 25 days in the ciprofloxacin group (p < 0.0001). The median of Gram-negative infection-related antibiotics was 10 days in the levofloxacin group compared with 20 days in the ciprofloxacin group (p < 0.0001). The number of days with body temperature ≥38 °C was significantly less in the levofloxacin group (p < 0.001).

The Effect of Pharmacist-Led Intervention on Surgical Antibacterial Prophylaxis (SAP) at an Orthopedic Unit

Perioperative antibiotic use is a common reason for antibiotic misuse. Evidence suggests that adherence to SAP guidelines may improve outcomes. The purpose of this study was to analyze the impact of pharmacist-led antibiotic stewardship interventions on SAP guideline compliance. The study was conducted at an Orthopedic Department of a tertiary care medical center. SAP compliance and antibiotic exposure in the pre-intervention and intervention period was compared using chi-square, Fisher exact, and Mann-Whitney tests, as appropriate. Prophylactic antibiotic use in orthopedic joint arthroplasties (overall guideline adherence: agent, dose, frequency, duration), clinical outcomes (length of stay-LOS, number of surgical site infections-SSIs), antibiotic exposure and direct antibiotic costs were compared between pre-intervention and intervention periods. Significant improvement in mean SAP duration (by 42.9%, 4.08 ± 2.08 vs. 2.08 ± 1.90 days, p ˂ 0.001), and overall guideline adherence regarding antibiotic use (by 56.2%, from 2% to 58.2%, p ˂ 0.001) were observed. A significant decrease was observed in antibiotic exposure in SAP (by 41%, from 6.07 ± 0.05 to 3.58 ± 4.33 DDD/patient, p ˂ 0.001), average prophylactic antibiotic cost (by 54.8%, 9278.79 ± 6094.29 vs. 3598.16 ± 3354.55 HUF/patient), and mean LOS (by 37.2%, from 11.22 ± 6.96 to 7.62 ± 3.02 days, p < 0.001); and a slight decrease in the number of confirmed SSIs was found between the two periods (by 1.8%, from 3% to 1.2%, p = 0.21). Continuous presence of the clinical pharmacist led to significant improvement in SAP guideline adherence, which was accompanied by decreased antibiotic exposure and cost.

Infective Endocarditis in Patients with Hypertrophic Cardiomyopathy

A literature review is presented, reflecting the incidence, etiology, hemodynamics, localization, clinical manifestations, outcomes and treatment of infective endocarditis (IE) in patients with hypertrophic cardiomyopathy (HCM). Despite the relative rarity of IE in patients with HCM, the combination of these pathologies is characterized by mutual aggravation and poor prognosis. The addition of IE increases the risk of death in patients with obstructive HCM, deteriorating circulatory disorders, increasing the likelihood of uncontrolled sepsis and embolism. Conservative treatment of IE in patients with HCM does not differ from that without HCM. Interdisciplinary interaction is needed in the management of patients with IE against the background of HCM in determining the indications for cardiac surgery and choosing the optimal method. Antibacterial prophylaxis of IE before invasive medical manipulations in patients with HCM is not recommended by the current consensus documents, however, the decision for each patient should be made individually, with a mandatory assessment of the risk of IE, the severity of hemodynamic disorders and prognosis.

Options for antibacterial prophylaxis of infectious complications of prostate biopsy

Introduction. Amount of prostate biopsy procedures rises every year and up to 95% of cases of prostate biopsy is performed via transrectal approach. The incidence of infectious complications of transrectal prostate biopsy reaches up to 17%, while incidence of such complications of transperineal biopsy is about 1%. The majority of international clinical guidelines recommends for obligatory antibiotic prophylaxis prior to prostate biopsy of any approach, but the choice of antibiotic is still debatable. The aim of this review is to sum up the approaches of international urological guidelines to the antibiotic prophylaxis prior to prostate biopsy. Materials and methods. We analyzed the search results in the scientific databases PubMed, Google Scolar, elibrary.ru for the queries «prostate biopsy», «antibacterial prophylaxis» and «guidelines». Results. According to the recommendations of most professional communities, antibacterial prophylaxis of infectious complications of prostate biopsy can be carried out in various ways - once or for a long time, one- or two-component, empirically or on the basis of urine culture on microflora. Conclusion. Despite the differences in the levels of sensitivity and resistance of coliform flora around the world, the clinical guidelines in most countries are uniform in terms of the choice of drugs to reduce the risk of developing infectious complications after prostate biopsy. Approaches to antibacterial prophylaxis after prostate biopsy differ only depending on the type of biopsy access.

The first experience of transperineal prostate biopsy without antibiotic prophylaxis

Objective: to study the safety of omitting the antibiotic prophylaxis before transperineal prostate biopsy.Materials and methods. The prospective randomized study included data, obtained during the diagnostical process of 85 patients, who underwent transperineal prostate biopsy in 2020. In the control group (n = 50) patients received 1 g Ceftriaxone IV 1 h before the biopsy. In the study group (n = 35) biopsy was performed without previous antibacterial prophylaxis. Age median was 63.2 (52-75) years.Results. No significant differences in the infection complications rate (UTI, soft tissues infections, prostatitis, fever, sepsis) were obtained between the groups. No patient developed UTI, prostatitis or sepsis, confirmed with urine culture.Conclusion. Performing transperineal prostate biopsy without antibiotic prophylaxis seems to be a safe alternative to common prophylaxis regiments, dedicated to infection complications prevention after prostate biopsy.

Physicochemical and antibacterial activities of Apis honey types derived from Coorg, Karnataka, India

Natural honey has various ingredients in it that contribute to its incredible properties. The aim of this investigation was to evaluate the physicochemical and antibacterial activity of various Apis honey from Coorg, Karnataka. Four samples of Apis honey viz., A. florea, A. mellifera, A. cerana and A. dorsata were collected from various regions of Coorg, Karnataka. The honey samples' physicochemical properties and antibacterial activities against Streptococcus sp., Staphylococcus aureus, Bacillus subtilis and Enterococcus sp were determined in vitro. The moisture and ash content varied from 13.6 - 17.2% and 0.32 – 0.49%, respectively. Hydroxy methyl furfurals) content of A. dorsata honey samples was highest with 9.2±0.5 mg/Kg and least was recorded with 6.8±0.4 mg/Kg for A. florae honey. The reducing sugar content of A. florea honey sample was highest with 87.5±3.2 (%) and the peroxide levels were in the range of 10.2 – 14.9 µg/g/h at 20°C. The antibacterial assay revealed that S. aureus, Enterococcus sp and Streptococcus sp were most susceptible against the honey varieties tested and minimum inhibitory concentration (MIC) values between 25-6.5 (%v/v) were determined. In conclusion, honey varieties from Coorg could be used in specific antibacterial prophylaxis as the activity depends on the honey bee species, their metabolism and floral sources in specific geographical regions.

Endogenous intoxication syndrome in pyelonephritis and methods of its therapy with the use of nutrient support

Endogenous intoxication syndrome in pyelonephritis and methods of its therapy using nutritional support G.M. Letifov FSBEI HE «Rostov State Medical University Ministry of Health of Russia Rostov-on-Don Summary The aim of the study was to scientifically substantiate and determine the prospects for the use of nutritional support in the form of the use of dietary supplements containing a complex of natural dietary fibers, inulin (from artichoke), effective probiotics-short-chain fructooligosaccharides, maltodextrin 1.5 teaspoon 2 times a day. The course of treatment is 3 weeks. The appointment of a prebiotic complex, prevention of dysbiosis and restoration of the intestinal barrier function significantly reduced the risk of re-entry of opportunistic intestinal flora into the urinary system, thereby reducing the need for antibacterial prophylaxis of recurrent pyelonephritis.

Preoperative Microbiological Screening in Pediatric Assessment of Skeletal Dysplasias Cases Before Planned Orthopedic Surgery

We report the preoperative microbiological screening of gram positive bacteria as a promising diagnostic approach for precise pediatric assessment of children with skeletal dysplasias who have undergone planned orthopedic surgery within a period of 10 years. The study was conducted on children with 29 different clinical diagnoses with preoperatively measured haemoglobin, platelets, blood glucose, serum glutamic-oxaloacetic transaminase, serum glutamic-pyruvic transaminase, serum creatinine, total protein, and fibrinogen. The performed preoperative microbiological screening involved the examination of nasal and throat secretions aiming to detect carrier and/or colonization of potentially pathogenic microflora in these upper respiratory tract niches. The documented statistical data demonstrated that 50.8 % of the cases had normal microflora, however the rest 49.2 % of the patients had potentially pathogenic bacteria. Among them, S. aureus was identified in 39.3% (as methicillin-susceptible or MSSA) and in 3.3% of the children (as methicillin-resistant or MRSA). The other predominant gram-positive bacteria were S. pneumoniae, S. pyogenes, M. catarrhalis, and C. albicans in 1.6, 0.8, 2.4 and 2.4 %, respectively. The infected patients have been at significantly higher risk for staph infections after surgical procedures than those with normal microflora. The presented microbiological screening proves the need for obligatory preoperative eradication of MRSA from nose niche, oral preoperative treatment of Streptococcus pyogenes and personalized preoperative antibacterial prophylaxis.